Transanal endoscopic microsurgery versus laparoscopic lower anterior resection for the treatment of T1-2 rectal cancers.

Background/aims: It remains unknown whether transanal endoscopic microsurgery (TEMS) is superior to laparoscopic lower anterior resection (LAR) for the treatment of rectal cancer. This study aimed to compare the surgical and oncological effectiveness as well as safety of TEMS and LAR in T1-2 rectal cancer patients.

Methodology: T1-2N0 rectal cancer patients were prospectively and randomly assigned to local excision using TEMS (n=30) or radical resection using LAR (n=30). The primary outcome measures were postoperative recovery course.

Results: The operative duration of TEMS was significantly shorter than that of LAR (130.3±16.7 minutes vs. 198.7±16.8 minutes, p<0.01). The TEMS group restarted bowel movement significantly earlier than the LAR group (51.4±5.4h vs. 86.2±8.7h, p<0.01). The postoperative complications were mild and self-limited in the 2 groups. Local recurrences occurred in 2 T2 patients (2/28, 7.1%) at 8 months and 16 months following TEMS, respectively; no patient (0/30, 0.0%) developed local recurrence following LAR.

Conclusions: TEMS was associated with more rapid postoperative recovery and minimal surgical morbidity in T1-2 rectal cancer patients as compared to LAR.